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This past weekend saw the advent of a new Christmas blockbuster short film. The feature involves the hastily set-up and staged visit of Ukrainian presidential candidate, Viktor Yushchenko, to the private Austrian clinic Rudolfinerhaus, where he came to be quickly diagnosed as POISONED -- a diagnosis that previously eluded doctors for months. The morality play was a nauseating piece of frivolity designed to take the heat off Yushchenko who was, at first, dealt with sympathetically by all for many recent medical problems. However, increasingly, with all the questions (especially regarding alcohol consumption) about Viktor's true medical condition, the Ukrainian leader was determined to get this topic off the public’s radar as a new election looms.

CODEBLUEBLOG STATSUMMARY

If you don’t want to read the whole post

Top Ten Reasons Why This Weekend’s Yushchenko Diagnosis is a Fraud:

10. It is hard to believe that while Viktor was acutely poisoned (with poison everywhere in his blood, sputum, sweat, and semen); they missed the diagnosis but now, MONTHS later they make the diagnosis in twelve hours (they say someone fortuitously developed a new test recently to make the diagnosis).

9. A real expert in poisoning says this would be a unique case in the history of forensic toxicology.

7. There are many major medical institutions and hospitals throughout Europe; why does Yushchenko keep going to this private clinic (it’s actually a keep-away clinic for the rich and Euro-famous -- you know the type) if he’s really concerned about getting help – did Bill Clinton go to a hideaway hospital for his bypass?

6. Rudolfinerhaus had to send the blood samples to another hospital/clinic in Amsterdam to get the answer (they did that fast, didn’t they?) Why didn’t Viktor just go to Amsterdam himself?

5. Viktor’s wife was brought in to tell some egregious and laughable tales, like “I just remembered... I tasted the poison that night when I kissed him.” As my daughter would say: OH… MY… GOD!

4. Dioxin is a chlorine-based fat- soluble compound. Chlorine stinks. And Dioxin doesn’t dissolve in water. So the brilliant spies are trying out a new way to poison someone with a chemical that stands out in water like an oil slick and stinks like Limburger cheese left all day in the dry sauna --- is that likely?

3. Being fat-soluble, Dioxin would be absorbed by many organs – especially the liver – and these organs would contain that fatty compound for months, at least, if not years. Yet Zimpfer says there are no traces of Dioxin in Viktor’s liver or pancreas. He also said Yushchenko’s Dioxin levels “have returned to normal.” That is not possible.

Research shows without doubt that Dioxin remains in humans – in their fat and liver – for many years. The half life of Dioxin in humans is seven years. So, if Yushchenko’s Dioxin levels are normal – then he was never poisoned!

3 a. Zimpfer cannot know #3 unless they did a large core liver biopsy this weekend, which they could not have done. And these biopsies take days to fix, stain and analyze.

2. The doctors in Austria have not offered even one shred of quantitative data (for perusal) to back up their claim. Not one lab test or pathology result. They didn’t even mention (oops!) which tests they did! They simply said the tests were positive for Dioxin. They have not produced any documents or other doctors who have SEEN the results. Only Zimpfer. And he’s a shill – that’s already proved.

1. Yesterday Yushchenko announced that he does not want any official investigation into his “poisoning” until after the elections. Ha! Why? Because he says he doesn’t want it to affect the outcome. Hasn’t it done that already? He means he doesn’t want it to affect the outcome the wrong way!

The Whole Christmas Story

Lights!

The Cast Arrives

Filming done, Viktor Yushchenko will go on with the Ukrainian presidential election today, after he and his Rudolfinerhaus claque (or quacks?) acted out a poorly scripted passion play this weekend manufactured solely to prove – for once and for all – that Yushchenko had been poisoned. With widespread and immediate acceptance by the entire world – including every single media outlet – this bold and silly Holiday movie may spawn a new round of reality television programming or even a return to cinema verite.

Did any one fall for this? I hope not. I certainly expect that readers of this column were more skeptical of the ridiculous sequence of events this weekend.

Four days after announcing he would not return to Rudolfinerhaus -- the Viennese medical clinic that couldn’t diagnose Viktor’s disease the FIRST time he was there -- the Ukrainian presidential candidate showed up, unexpectedly, on Friday afternoon in dramatic fashion.

He returned – whisked in by a black motorcade of limousines -- for the “blood and tissue tests” that doctors assured us they NOW could handle.

Because Your Kiss is on My Lips!

They hustled Viktor into the clinic and left his wife, Katerina standing outside for an interview, at which time she gave a performance that not even Marlene Dietrich in her prime could have topped. Passionately, Katerina breathlessly spoke to spellbound reporters, delivering this set-up line:

"I know in my heart that he was poisoned and it will be medically established today,"

Oh really? What Katerina didn’t tell the reporters is that her statement was not said with prescience; rather, it was said with advance information. No time for that, however, as Katerina was not done playing the opening act of this weekend’s gig. She had one little zinger to add. Speaking of an embrace she had with Viktor the night he was eating with the Ukrainian Secret Service she blurted out something I’m sure I read in Anna Karenina:

I smelled the poison on his kiss

As my daughter would say OH… MY… GOD!!! She just remembered this? Did the reporters start CHOKING? You smelled the poison on his breath? Are you sure? I mean, he did have sushi, right?

Who wrote this script anyway, the Brothers Grimm?

Camera!

Bing Bang Boom – Case Closed

Saturday morning – twelve hours later -- Rudolfinerhaus releases a statement saying they will tell the world the answer to the poisoning question at precisely 1400. That’s a pretty good prediction for a team that has admitted the case is baffling, difficult to solve, and one that may not have an answer. I mean it was just a couple of months ago when they had Yushchenko in their clinic for an extensive stay during the acute illness (when the poison would have been EVERYWHERE detectable in his system – in his blood, urine, sputum, semen) and yet they were stumped for all those weeks – and NOW he returns and within twelve hours they are giving an exact time for the diagnosis.

Time arrives for the announcement (Stage Left: bring on the dancing girls):

Rudolfinerhaus’ director, the frequently confused, double-talking Dr. Zimpfer straightens out his pince nez and clears his throat. The amazing Doktor, in the weeks since Yushchenko’s discharge, has become an expert in Dioxin and Dioxin poisoning.

Before I let the Zimpferisms spin your head, let’s get a few things straight about Dioxin.

Oily, Stinky, and Unknown – Borscht?

Dioxin is an unintentional breakdown product formed in many industrial processes involving chlorine, such as waste incineration, chemical and pesticide manufacturing, and pulp and paper bleaching. So, it’s a chlorinated compound – and chlorine products generally STINK (take a whiff of the pool cleaner some time).In an EPA dioxin report, they refer to dioxin as hydrophobic (water-fearing) and lipophilic (fat-loving). This means that dioxin will not mix with water – only fat-containing substances—so, in order to poison someone with Dioxin you need to mix the Dioxin in with fat. NOT soup (what kind of soup are they eating?).

Asked what he thought about the details of trying to poison someone with Dioxin, a real expert, British toxicologist John Henry threw up his hands:

We've never had a case like this — a known case of large, severe dioxin poisoning

And You Thought Yogi Was Quotable?

With this preface, let’s examine some Zimpferisms that came out of the press conference (my replies in italics):

“If this dose had been higher, it may have caused death”

No one knows how much Dioxin it takes to kill someone – even nefarious spies, apparently, eh? So, how do YOU know what the dose was and that more would have been fatal?

What amount? See above.... being hydrophobic, Dioxin would stand out in soup like an oil slick

If they did dose his soup with the chlorinated poison, don’t you think Yushchenko would have sniffed it out – I personally HATE the taste of chlorine in MY soup; and, didn’t his wife smell it on his breath HOURS later? So what did it smell like IN THE BOWL? Maybe Viktor had a cold.

(Zimpfer …added) it is impossible to determine exactly how the poisoning took place

So the soup thing is a guess? Is this something Austrian doctors regularly do in tough cases?

The hospital believed it had been a deliberate act of poisoning; “We suspect a cause triggered by a third party”

I thought it was “ impossible to determine exactly how the poisoning took place?”How do you work backwards from that to deduce a third party?

Besides, what new high-technology test indicated this? A motiveometer? These doctors are GOOD.

Zimpfer said it would take years for Yushchenko's body to rid itself of the dioxin

This is one correct thing Zimpfer said. Fat-soluble compounds (especially poisons) will remain in the liver (especially) and other organs for months or years or a lifetime

Doctors said dioxin levels in Yushchenko’s liver have now returned to normal and he is expected to be released from the hospital in the next few days

Oops! A bad contradiction. Zimpfer cannot know the concentration of Dioxin in Yushchenko’s liver unless they did a large core liver biopsy this weekend, which they could not have done in this time frame. And these biopsies take days to fix, stain and analyze.

Yushchenko was in satisfactory condition and his dioxin levels have returned to normal

So if Yushchenko’s Dioxin levels are normal now, that means he was never exposed to the agent! Here’s a small sampling from the literature:

The extreme persistence of dioxin in humans means that, once exposed, we continue to receive low doses from our body fat

Men have no ways to get rid of dioxin other than letting it break down according to its chemical half-lives

Dioxin's "half-life" in the human body is about seven years. In other words, it takes about seven years for half of the dioxin in your body to be removed

Dioxin binds very strongly to intracellular receptors in the nuclei of animal and human cells throughout the body. So dioxin can easily get into the nucleus, where the cell's DNA is located

Researchers from four countries across Europe, supported by one of the EU's research programmes, have produced further evidence of the multiple, long-term effects of dioxin on human health. Follow-up of 159 workers in the Austrian chemical industry who were exposed to dioxin shows that these effects can be detected more than 20 years after exposure. The findings have just been published in the international scientific journal, Environmental Research. The extremely long half-lives of dioxins in humans means that exposure can still be assessed in blood fat many years after the event.

ACTION!

Confused? Don’t worry, they are too

This whole little drama was staged because Yushchenko’s poisoning was starting to work against him. People were more interested in what was wrong with Yushchenko than in the election itself. So he had to put the whole thing to rest. Viktor called up the accommodating Dr. Zimpfer, briefed his wife (who probably ad-libbed the melodrama kiss part much to the director’s chagrin), and sped away to the private little clinic where they made quick work out of a diagnosis that previously had stumped the world, and now everything is OK and Viktor is going to be OK and the Dioxin will GO AWAY and let’s not talk about this anymore, OK?

A Frank Capra Denouement

And if you don’t believe that this was all staged ask your self two questions:

1. Why has not anyone at any time this weekend – in all the fanfare and all the pomp – given us ONE IOTA of quantitative evidence to examine? WHAT tests were abnormal? SHOW us a test result or a slide or SOME OTHER expert (who Zimpfer is not, by the way) who says he has SEEN the results and they are DISAGNOSTIC. None. Nobody. Nothing

2. Yesterday, Yushchenko said that he does not want anyone looking at any of this Rudolfinerhaus poisoning work-up carefully because he does not want it to affect the election! His words:

"This question will require a great deal of time and serious investigation. Let us do it after the election - today is not the moment."

Tell you what, Viktor, just show us one lab slip that has the box: Substance Confirmation: Dioxin checked on it.Show us one computer print out. Let us hear from one lab expert or pathologist who saw the quantitative data and agrees: this is definitely, no doubt, absolutely, Dioxin poisoning.

In a scene that was hokier than Jimmie Stewart findingZuzu’s petals in his pocket, Yushchenko spoke, with his wife, to the press on Sunday, as he left the triumphant Rudolfinerhaus clinic – a children’s choral group singing in the background! Yushchenko addressed the world thanking the Zimpfer-lead team:

And I want to thank their team. They've spent many days and nights with me. I am very happy to be alive in this world today. And I thank these people for this.

Comments

"However, increasingly, with all the questions (especially regarding alcohol consumption)"
I thought it was bad sushi, comrade. Stick to the real script, eh? Must be some nasty Wodka to give that sudden chloracne after a presumed lifetime of tippling. Methinks you bang your drum (while operating hi-hat with armpit and blowing kazoo) a little loudly at this stage of the game. Your "debunking" has the same stench of bad theater you claim to be sniffing out.

A couple of quibbles, offhand...
First, while I don't know what dioxin smalls like, I do know that not all chlorine compounds smell anything like chlorine... nor like anything for that matter. Saran wrap, prior to the recent reformulation, was actually made fron saran, which is primarily polyvinylidene chloride -- and it's pretty odorless (though noted for not dissolving in soup). Chlorofluorocarbons (Freons) tend to be nearly odorless, too (at least, the ones that used to be in common use).
Second, just because something is hydrophobic doesn't mean it can't be hidden in soup, as long as the soup has some fat content; the existing oil slicks in the soup could contain any fat-soluble substance. (Hiding a fat-soluble poison in the fat in a soup might imply more than casual access to the soup during preparation.) The last bowl of chicken soup I ate certainly had little fatty oil slicks floating around on the surface, and I didn't find this alarming.

If you scroll back a little, I spend a lot more time in previous posts describing the link with alcohol ingestion via pancreatitis.

As I have said many times, if you take the end known results (the signs and symptoms of the illness) and combine those with the known clinical course -- as we've been given -- and attach probabilities as to the CAUSE, then poisoning is low on the list of differential diagnoses.

Pysicians face these kinds of "mysteries" every day in the ER. If Yushchenko walks in and has pancreatitis and says he was out at a big dinner last night and then develops multiple complications, you would be committing malpractice to diagnose him with and treat him for Dioxin poisoning. Until we have data. They say they have data. If they would just SHOW us the data I would say: "Okay, an unlikely thing occurred to cause this illness." I have no problem with that.

But this past weekend's performance was strictly a put-on, make no doubt. Yushchenko went all that way and created all this media attention to GET HIS BLOOD DRAWN for a supposed "new" test to show Dioxin poisoning. His blood could have been drawn anywhere -- they shipped it OUT to Amsterdam!

The points I raise are holes in the story. A story that is AT LEAST partly concocted and staged. Maybe a fistful of greasy Dioxin smells like tomoatoes and goes down like butter, but there are too many inconsistencies and contradictions.

Besides, Katerina smelled it on his breath HOURS LATER, right? So it had to have some lasting aroma and flavor!

Hmmm. You're a radiologist (so you say). Not a toxicologist, not an ER doc. A radiologist. And this makes you an expert on dioxin poisoning how?
Dioxin is nothing like chlorine, comrade. Not in taste, odor, consistency, or any other characteristic. It dissolves in fat, so that a fat-based soup or any other fat-based food might serve.
Your diagnosis of rosacea is good for comic relief.

You may be a great guy in real life, smart and wise, but on the blog you come across as something else.

People are pretty hung up on the chlorine and fat- soluble issues, I see. Those really are minor points, come on. I threw them in there really because of how casually Zimpfer just assumes one can get Dioxin into someone's dinner, and that was juxtaposed with the ridiculous claim by Yushchenko's wife that she smelled "poison" on her husband's breath hours later.

Not many people have complete expertise in everything, but I have thousands upon thousands of hours of study in science, multiple degrees (the equivalent of 2 PhD's), twenty years of experience -- and I did the research, so what else do you want from a blogger, eh?

As for Rosacea, you can laugh at me, but right back at ya -- becuase you're wrong. It certainly could be rosacea (as I have explained many times in previous posts) which can come on in explosive fashion and be extremely disfiguring.

Most importantly, my friend, it is a COMMON problem and there is an old saw used for those who simply do not know enough math to understand statistics and probabilities and it goes like this:

It is MUCH MORE LIKELY that you will see an uncommon manifestation of a common disease than a common manifestation of an uncommon disease.

The symptoms of "chloracne" from dioxin poisoning are consistent with Yushchenko's condition.

Many commentators have been saying this for close to a month now.

The fact that it took doctors a long time to come out and actually announce this is consistent with my experience with ... doctors. (And would be especially true in a case of the attempted poisoning of a public official in the midst of an election battle - like this case).

For the symptoms of "chloracne" from dioxin poisoning, see, for example, here:

Acne is a SIGN not a SYMPTOM. Signs, in medicine are end-results. Because of this, they can be deceiving when trying to make a diagnosis -- becasue many pathophysiologic pathways can lead to the same signs.

I saw those Google images of chloracne a long time ago and I never thought that the blackheads and pimples shown in those images resemble Yushchenko's facial lesions.

Pardon my saying this again (I said it above) but:

It is MUCH MORE LIKELY that you will see an uncommon manifestation of a common disease than a common manifestation of an uncommon disease.

So I look for COMMON reasons for whatever I find FIRST. Then, if data prove me wrong, I move to the unl;ikely diagnosis.

I AM NOT SAYING YUSHCHENKO COULD NOT HAVE BEEN POISONED WITH DIOXAN.

I AM saying it is -- and remains -- unlikely...a position one is FORCED to take by logic, especially when you have to treat patients.

i think one can logically deduce from Dr. Boyle's summary at the top that the poisoning is a hoxa. 3 and 4 disprove it and 2 shows they are doing a song and dance routine to avoid the issue. Even if commenters here are correct about one point, the other nine seem to build a tough case against the dioxin poisioning.

Here's another angle - the Yushchenko posse (incl. bought-off medics at the Rudoflinerhaus, if not for the 15 minutes) claims "they" wanted to poison him. To what effect? To kill him? To disfigure his face? Given the largely varying opinions on the lethality of dioxin we have at least two options: (1) "They" wanted to kill him, but failed. (2) "They" wanted to disfigure his face, and succeeded. But wait, what about other options? (3) "They" took into account killing him, but a disfigured face is nice as well. (4) "They" wanted to let him die later, but unfortunately the disease broke out prematurely.

In whatever way you turn it, the whole setup smells like a beweisorgie. There's just too much signs hinting at evil, dark forces *cough* Yanukovich *cough* that you better believe the opposite. Russian intelligence, Ukrainian intelligence, Putin and gang causing that much noise to take Yushchenko off the track? Give me a break.

I followed a link here hoping to pick up some info on this situation, but I only made it halfway through the post before I gave up. You've got some kind of axe to grind - personal or political - I don't know. The post reads like something I read on Daily Kos that "showed" the CBS Bush National Guard memos were "probably" genuine. Make a big deal out of minor inconsistencies and omit a couple of facts and bingo! -- you've got yourself a new conspiracy theory.

I do however agree with your old saw that an uncommon instance of a common problem usually beats a common instance of an uncommon problem - but I think you've got your definitions mixed up. Dioxin poisoning from the envirionment is surely uncommon -- unless you happen to live in an environment where somebody might want to poison you with dioxin. That changes the odds. And that's the issue, isn't it? We're not talking about some kind of naturally occuring life style disease here, although that may turn out to be the case. The charge is attempted murder or disability. Your uncommon/common old saw doesn't cut that wood.

It might be of interest in this connection that the amazing Dr. Zimpfer, who the MSM has largely implied is in charge of medical matters at the Rudolfinerhaus clinic, was at least until late in fact the president of the clinic's supervisory board: that is, in effect, an administrative officer. The actual medical director was until last Thursday one Dr. Lothar Wicke. One day before Viktor Yushchenko arrived for the latest alleged round of tests that miraculously seem to have resolved the medical mystery that two earlier visits to the clinic at the height of his illness could not, Dr. Wicke resigned. Since Viktor Yushchenko first checked in to the Rudolfinerhaus in early September, Dr. Wicke has persistently maintained that the diagnosis of poisoning is scientifically unfounded. For his trouble, he has by his own account been the object of threats coming from Yushchenko's entourage - in at least one case apparently relayed by Dr. Zimpfer - designed to encourage him to keep quiet or retract his opinion. In October, he was assigned an armed guard by the Viennese police. For more on "The Strange Case of Dr. Wicke", see here:

In further evidence supporting CBB and refuting his detractors, the clinical data on chloracne appearing in Nikita's own blog strongly argues against the hypothesis that the condition could have arisen one day after eating the contaminated food:
"Chloracne is a rare acne-like skin condition caused by certain toxic chemicals including the dioxins. It develops A FEW MONTHS AFTER swallowing, inhaling or touching the responsible agent." (quote from http://nikita_demosthenes.blogspot.com/2004_11_28_nikita_demosthenes_archive.html#110186226265596130 ; capitals are mine)

Some of CBB's detractors (such as Hyperias above) appear to imply that VY's constellation of signs & symptoms is a common presentation of dioxin poisoning. VY's primary diagnosis, however, in September was ACUTE PANCREATITIS, a condition NOT known to be associated with dioxin poisoning. How do supporters of the dioxin theory account for pancreatitis?

1. So dioxin poisoning only produces chloracne effects on the the face, ears ? Nowhere else?
2. I haven't been poisoning anyone recently but if I did, I really do believe that there are a few easily obtained, relatively untraceable chemical routes I might just consider.
3. If they wanted to kill him , why didn't they just shoot him - that's the usual method in those parts.

As an expert on dioxin formation in comubustion systems, I have been involved in numerous scientific studies on the chemistry, formation, analysis, and effects of dioxin on living systems and the environment. So let's take a couple of your arguements step by step.

YOU SAY "Dioxin is a chlorine-based fat- soluble compound."

FACT: True so far.

YOU SAY: "Chlorine stinks.....(Dioxin is)..a chemical that .....stinks like Limburger cheese left all day in the dry sauna."

FACT: Dioxin has no odor. First, in order for a compound to have an odor, it needs to have some degree of volatility (volatility, simply put, is the ability of a compound to turn into a gas, allowing it to reach our nose and be smelled), and dioxin has is non-volatile. Second, although I doubt any odor studies have been performed (or can be performed due to its non-volatility), the structure of the compound would not be conducive to sensitivity by our odor receptors.

Lastly, just because something is cholrinated does not mean it going to smell like your swimming pool - think about table salt (sodium CHLORIDE), which has no odor. Plastics made from PVC (after residual vinyl choloride has leached out)have no odor, and somebody else mentioned Saran wrap has no odor.

YOU SAY: "Dioxin doesn’t dissolve in water... chemical that stands out in water like an oil slick."

FACT: You're right to an extent on solubility in water, however, solubility is a matter of degree. Dioxin is very slightly soluble in water, just as are other chlorinated compounds like PCBs, PVCs, etc. However, it's water solubility is not the issue. An account in the "Australian" (which I found by Googling "Yushcenko", "dioxin" and "soup") said the dioxin was "probably given to him in a creamy soup". Creamy soup. Hmmmm... cream, fat, fat-soluble, duh!!

Also, we're not talking massive quantities here. I haven't done the math, but from the accounts I've read, I suspect the amount of dioxin administered is in the miligram range (a miligram is 1/1000th of a gram, or about a couple of grains of salt) so indicating it would form a slick indicates your lack of knowledge of the subject.

YOU SAY: "Rudolfinerhaus had to send the blood samples to another hospital/clinic in Amsterdam to get the answer" I believe your implication was "how come they couldn't do it themselves?"

FACT: Dioxin analysis is a highly specialized field, requiring specialized equipment (i.e., high resolution gas chromatograph/high resolution mass spectrometer), as well as the expertise to conduct the analysis. There are only a handful of labs in the world that can conduct this analysis, and even fewer that can conduct it well (there is not much call for dioxin analysis and the capital investment is high, so it makes no commercial sense to open a lab on every corner). So, it would make perfect sense for any clinic or lab to send their samples to one of these handful of labs to conduct outside dioxin analysis.

I'm not going to attempt to research any of your other points - but I can speak as an expert on the above. But the fact that you've gotten these so wrong leads me to doubt the credibility of your other points.

dabrick, you are correct on some chemical aspects of the story. Yes, TCDD is indeed odorless, and Katerina Yushchenko, who "smelled poison on his lips", should be kindly informed about this. Also, yes, TCDD can be dissolved in a fatty soup. However, since you are so critical of CBB and you claim to "...have been involved in numerous scientific studies on the chemistry, formation, analysis and effects of dioxin on living systems", here are some questions for you:
(1) Are there any reported cases of acute pancreatitis (which VY had) due to TCDD poisoning?
(hint: don't spend too much time searching for this)
(2) How long after TCDD poisoning is chloracne starting to appear? Could VY have developed it next day after the Secret Service soup?
(hint: for the case of highest TCDD blood levels reported, see http://ehp.niehs.nih.gov/docs/2001/109p865-869geusau/abstract.html?section=environmental )

(2) "How long after TCDD poisoning is chloracne starting to appear? Could VY have developed it next day after the Secret Service soup?"

Obviously (and furtunately) exposure to high TCDD levels is rare. The exception to that is the accident that happened in Seveso, Italy in 1976, where an industrial accident exposed the town to high dioxin levels.

According to several accounts I've found by Google'ing "seveso" and "chloracne", some immediate effects were noted, particularly in children:

So yes, effects can be noted immediately after exposure. Keep in mind, the Seveso exposures were inhaled, not ingested, and were not as severe as suggested here.

(1) "Are there any reported cases of acute pancreatitis (which VY had) due to TCDD poisoning? (hint: don't spend too much time searching for this."

I won't, because I know the body of knowledge on dioxin exposure is, fortunately, quite limited. With good reason, we generally don't expose people to high levels of poisons, then conduct epidemological studies to note effects.

Are there reported cases of acute pancreatitis due to TCDD poisoning? I'll agree - quite possibly not (BTW - no matter what Google, Inc. wants you to think, the whole body of scientific knowledge can't be found by plugging some terms into Google). However, how many cases of ingested dioxin poisoning are on record? You noted one in the reference you provided (although the route of exposure was indeterminate, and I'm having trouble comparing levels since the news reports I can find on VY don't provide enough detail to allow comparisons). If there were 50 more cases, would pancreatitis be noted in any? I don't know, neither do you.

Note one thing, however. Although there does not appear to be proof of TCDD pancreatic toxicity, there is at least one case of pancreatic carcinoma after exposure, poteitially indicating at least some accumulation in that organ. At Seveso, a 55 year old woman "died from pancreatic adenocarcinoma 7 months after the explosion" (http://www.cdc.gov/mmwr/preview/mmwrhtml/00001310.htm). Obviously, this is VERY annectdotal (it's a single case and who's to say it was the dioxin that caused the cancer?), but if we want to stretch our imagination......

The diagnosis of pancreatitis may have nothing to do with dioxin poisoning. Pancreatitis commonly occurs after a large meal and a bout of drinking. Precisely the reported activity of VY on the night in question. The smell that his wife detected on her husband's breath may well have been a result of keto-acidosis, a symptom of high sugar levels seen in diabetes. Diabetes is a common sequelae of acute pancreatitis (the pancreas is the source of insulin) .
However AFAIK pancreatitis does not produce acne like rashes. So the diagnosis of pancreatitis does not rule out dioxin poisoning. It may in fact be a perfectly reasonable primary diagnosis in this case.

I'd also note that dabrick's reference(above) to accounts of acute dioxin poisoning states that both patients had 'non-specific gastro-intestinal symptoms'. Which leads me to conclude that the diagnosis of pancreatitis may be wrong, rather than the diagnosis of dioxin poisoning. Which also explains why it took months to reach a 'correct' diagnosis.

Thanks to dabrick for a thoughtful post. I am here responding on the issues he discusses on chloracne temporal profile and on pancreatitis.
Thanks to CBB for brilliantly developing an exciting theory for VY's ailments. I am here summarizing and building on his hypothesis.

CHLORACNE TEMPORAL PROFILE
Halogenated chemicals such as TCDD can generally cause 2 types of skin reactions: photocontact dermatitis and chloracne. The former can develop very fast, does not look greenish and is apparently the type of rash observed acutely after TCDD poisoning. Chloracne, which appears as reddish and greenish skin lesions, is slow to develop because it requires keratinocyte hyperplasia, hyperkeratosis and abscess formation, processes that generally take at least weeks to develop.
(For comprehensive discussion, see article by Yamamoto & Tokura, linked at pubmed: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12850300 )

VY reportedly developed a rash with greenish areas only days after his alleged poisoning on Sept. 5. I cannot totally rule out that chloracne took such a clinical course, but it would certainly stretch the limits of biological plausibility, something that should at least be critically addressed by medical experts and legal investigators.

The other problem with VY's "chloracne" is that its exact appearance changes by the day. See, for example, a good collection of recent VY photos at: http://cnn.netscape.cnn.com/ns/news/photosearch.jsp?cap=Yushchenko .
Significant daily changes are incompatible with the histopathology of chloracne and my guess is that they would not be observed clinically in a TCDD case.

A much more plausible explanation for the apparent rapid changes in the color characteristics of VY's rash is that they do not represent changes in chloracne but are the result of make-up applied to cover a reddish-looking rash (which could have any among a variety of causes, including alcohol-related rosacea).

PANCREATITIS
Everyone apparently agrees that acute pancreatitis is not a recognized complication of TCDD poisoning. Although an atypical case cannot be totally ruled out, the fact remains that pancreatitis argues against the diagnosis of TCDD poisoning.
As for the reported case of death from pancreatic cancer 7 months after TCDD poisoning, the time interval is incompatibly short with the natural history of cancer and it can safely be assumed that the cancer predated and was not caused by the poisoning.

MOST LIKELY DIAGNOSES, ASSESSMENT AND SUGGESTED PLAN
(1) Pancreatitis, most likely due to excessive alcohol use, and
(2) Rosacea (prominent, as expected, in nasal and malar areas) due to a combination of stress and alcohol.
Both diseases are common and their relation to alcohol (not necessarily at overtly intoxicating levels) is well established, as CBB has correctly pointed out.
A greenish make-up would be a logical choice to cover an embarrassing reddish rash. Allegations of poisoning would be an obvious tactic for a campaigning politician keen to turn an embarrassment into a powerful political weapon in a crucial election. As soon as somebody suggested "dioxin", all that the VY entourage had to do to "prove" poisoning was to find a little TCDD and add a drop in a blood sample collected by his private doctor.
There are 2 simple medical measures to resolve the puzzle:
(1) VY must be examined by independent doctors. Most importantly, it must be determined whether the greenish color represents skin lesions or is the result of make-up.
(2) VY must give new blood samples for TCDD levels, to be collected and handled by independent and reliable medical personnel.

kyan, you raise excellent diagnostic points. Note, however, that there is publicly available data convincingly showing that VY had pancreatitis. See the medical certificate from his first visit to Rudolfinerhaus:http://www.razom.org.ua/en/news/2357/
Of particular note:
- lipase 125 (normal 7-29) (amylase not given)
- Spiral CT: "pancreas intermittently massive without clearly defined edges".
The #1 diagnosis he is given is: "Acute pancreatitis with interstitial swellings, II degree". I see no reason to doubt it.

Now if the diagnosis of alcohol-related pancreatitis is correct, we still have to explain the rash. Rosacea, which can produce a variety of (reddish) facial lesions, is a well recognised complication of excessive alcohol intake. Stress (which VY undoubtedly had) is considered a triggering factor for rosacea. Whereas I am not aware of the frequency of simultaneous pancreatitis and rosacea, both are common sequellae of alcohol. As for the greenish appearance of VY's rash, I believe (as I wrote above, see photos at http://cnn.netscape.cnn.com/ns/news/photosearch.jsp?cap=Yushchenko ) that it is more compatible with make-up application rather than chloracne.

Some excellent deiscussion!! Much more thoughtful and logical than the initial posting here!! Thank you.

I will let you MD-types argue the other potential causes for the symptoms shown by VY - I'm not an MD nor do I play one in a Blog. I'll try to stick to the dioxin side of the discussion.

I'll repeat myself on the body of knowledge on acute and extreme dioxin poisoning - it is EXTREMELY limited. Dioxin is formed in combustion sources at very low levels (pg/m3), and it's presence in the environment is quite low (that's not to say it is of no concern). Consequently, most studies conducted to date have focussed on long-term, low level effects.

One thing I'll completely agree on - if you want to kill somebody, poisoning with dioxin is about the dumbest way to do it. It's persistance in the body makes it amenable to analytical techniques, once you know what to look for. There just aren't many sources of dioxin for such use, expediting tracking its acquisition. It's never been known to be fatal (at least not immediately).And finally, handling it can be dangerous to the poisoners.

But there are dumb criminals out there (see www.dumbcrimninalacts.com for some entertainment). One of the articles that Pythagoras C referenced (the highest dioxin levels recorded in humans) indicated that while this woman's exposure route could not be determined, it was possible that she was poisoned deliberately.